Monga G, Mazzucco G, Messina M, Motta M, Quaranta S, Novara R
Dipartimento di Scienze Biomediche e Oncologia Umana Sezione di Anatomia Patologica, Università di Torino, Italy.
Mod Pathol. 1992 Mar;5(2):125-30.
A total of 61 kidney allograft specimens (51 biopsies and 10 nephrectomies) from 44 patients were investigated. Transplant glomerulopathy (TGP) was found in 38 specimens. Electron microscopy disclosed peculiar intertubular capillary changes (ITCC) in 47 specimens (all those showing TGP and nine without TGP). They were characterized by splitting and multilayering of the basement membranes. TGP and ITCC were graded and found mild (in 23 and 22 specimens), moderate (in 11 and 16 specimens), and severe (in four and nine specimens). Both worsened with time lapse from transplantation. When both were compared in single specimens, their grading was similar or, with a few exceptions, more severe for ITCC. TGP and ITCC were more frequent in biopsies with morphologic evidence of rejection and less frequent in patients treated with Cyclosporine A. Repeated biopsies and nephrectomies were studied in 10 patients and a somewhat more precocious appearance of ITCC than of TGP was found. Earlier and more severe ITCC were found in two patients who had had two transplants as compared to those with one. Morphologic similarities between TGP and ITCC suggest a common pathogenetic mechanism related to endothelial damage. The association to the histological evidence of rejection as well as the apparently protective activity of Cyclosporine A could support the involvement of an immune-mediated mechanism in agreement with what is reported in literature. The constant association of ITCC and TGP and its possible more precocious appearance enforce the diagnostic value of the former, which allows to infer the presence or the subsequent development of TGP even in biopsies where glomeruli are lacking.
对来自44例患者的61个同种异体肾移植标本（51例活检标本和10例肾切除标本）进行了研究。在38个标本中发现了移植性肾小球病（TGP）。电子显微镜检查在47个标本中发现了特殊的肾小管间毛细血管改变（ITCC）（所有显示TGP的标本以及9个未显示TGP的标本）。其特征是基底膜分裂和多层化。对TGP和ITCC进行了分级，发现轻度（分别在23个和22个标本中）、中度（分别在11个和16个标本中）和重度（分别在4个和9个标本中）。两者均随移植后时间的推移而加重。当在单个标本中对两者进行比较时，它们的分级相似，或者除少数例外，ITCC的分级更严重。TGP和ITCC在有排斥形态学证据的活检标本中更常见，而在接受环孢素A治疗的患者中较少见。对10例患者的重复活检和肾切除标本进行了研究，发现ITCC的出现比TGP略早。与接受过一次移植的患者相比，接受过两次移植的两名患者中发现更早且更严重的ITCC。TGP和ITCC之间的形态学相似性表明存在与内皮损伤相关的共同致病机制。与排斥组织学证据的关联以及环孢素A明显的保护作用可能支持免疫介导机制的参与，这与文献报道一致。ITCC和TGP的持续关联及其可能更早的出现增强了前者的诊断价值，这使得即使在缺乏肾小球的活检标本中也能推断TGP的存在或随后的发展。
